Basic Information
| Provider Information | |||||||||
| NPI: | 1710927926 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PONCE PULMONARY GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2225 PONCE BYP | ||||||||
| Address2: | STE 703 | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007171379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878408284 | ||||||||
| FaxNumber: | 7878440225 | ||||||||
| Practice Location | |||||||||
| Address1: | 2225 PONCE BYP | ||||||||
| Address2: | STE 703 | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007171321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878408284 | ||||||||
| FaxNumber: | 7878440225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROSADO-TOLEDO | ||||||||
| AuthorizedOfficialFirstName: | HECTOR | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7878408284 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, FACP, FCCP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 7912 | PR | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.